Occasional Paper 10 - The Royal New Zealand College of General ...

• Define the owner – there was agreement that a shared vision and agenda will have an impact on which quality
tools and methods are used in the sector
• Measures – what should be measured? Development and use of indicators is dependent on the context and
environment
• Improvement – change depends on effective clinical leadership and governance, the culture of the sector, local
networks, national and frameworks and supporting resources
• Enhanced teams – the diversity of teams is changing in primary care and provides more scope to work differently
with individuals and across populations
• Practices – the building should provide the range of services and activities that support a quality learning
environment – space, culture of teamwork, range of health professionals, protected time, an IT infrastructure,
PMS, guidelines integrated with PMS systems, linkages to other primary and secondary services, diagnostics,
PDSA cycles of activity for monitoring
• Patient focused – tracking the patient journey – the electronic patient record is identified as the key to improvement
4. Pay for performance
Pay for performance should be carefully established with principles and parameters within an established framework
agreed to by the sector. An appropriate balance of incentives (financial, contractual, professional) is essential. There
are different perspectives that make it important to develop rules before it is established.
Pay for performance is not straightforward but the group was clear that payment should not be on the basis of data
collection. It should be linked to service improvement; savings made, efficiencies in services and effective outcomes
for patients. The group was not supportive of the approach taken by the UK where individual performance was resourced
instead of systems. Although the group supported pay for professionalism as an essential element to ensure health
professionals are properly resourced, performance must also be responsive to local needs.
5. Mechanisms for driving quality
Pre-requisites for quality – there are a range of mechanisms that the sector may identify. This should be in conjunction
with QIC e.g. professional standards, clinical governance, continuity/integration of care between primary/secondary.
The H&DC has a strong interest in safe and high quality systems that are based on ‘learning, not lynching’ – the Code
of Rights is cited as the best consumer framework and the principles are key. It is a good example of a simple framework
that can and has been applied across the sector.
Contracts are a powerful mechanism for driving quality but are dependent on the culture of sector. Contracts should
note exclusions or inclusion clauses to explain reporting.
6. Primary Care Health Workforce – professionalism
Recognition of the value of primary health care teams as a critical success factor in quality is essential. More health
professionals are working collaboratively and managing patient care as a team so increased clinical training opportu-
© THE ROYAL NEW ZEALAND COLLEGE OF GENERAL PRACTITIONERS / Summary of Proceedings 2008 15